Correlation between imaging studies and histological analysis in the assessment of microvascularization in lipedema

Objective To evaluate microvascular alterations in lipedema using a multimodal approach combining Micro Flow Imaging (MFI) ultrasound, infrared thermography, standardized clinical photography, and histological analysis. Methods Twelve women with clinically diagnosed lipedema involving the lower limbs (types III and IV, stages II–III) were included. Vascular assessment was performed using high-resolution ultrasound with advanced Doppler (Micro Flow Imaging) to detect low-velocity microvascular flow. Infrared thermography was used to identify abnormal thermal patterns, and standardized clinical photographs documented morphological changes. Punch biopsies (6 mm) from the lateral thigh were analyzed histologically using hematoxylin and eosin, periodic acid–Schiff, trichrome, Picrosirius red, Giemsa, and Perls stains. Results Ultrasound demonstrated increased subcutaneous thickness, connective tissue disorganization, and non-encapsulated hypoechoic nodules. MFI with spectral analysis revealed low-resistance arterial flow (resistance index <0.7) in microvessels surrounding these nodules, suggesting inflammatory activity. Thermography showed regional thermal differences (ΔT) between 0.5°C and 0.7°C, with focal hyperthermia indicating inflammation and areas of relative hypoperfusion suggesting microvascular stasis or fibrosis. All patients exhibited thermographic patterns consistent with altered cutaneous perfusion. Of 13 biopsy samples collected, 10 were analyzed. All samples showed adipose tissue hyperplasia with variable adipocyte size. Increased capillary density and mast cell infiltration were observed in 60% of cases, cytosteatonecrosis in 30%, and septal fibrosis in 10%. Conclusions Lipedema is associated with microvascular and inflammatory alterations that can be detected by noninvasive imaging techniques. The combined use of Micro Flow Imaging ultrasound and infrared thermography correlates with histological evidence of increased capillary density and inflammation, supporting the presence of an active inflammatory microangiopathy. This multimodal approach may enhance diagnostic evaluation and clinical monitoring of patients with lipedema.